US4994237A - Microwave preservation of bioprostheses - Google Patents
Microwave preservation of bioprostheses Download PDFInfo
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- US4994237A US4994237A US07/435,332 US43533289A US4994237A US 4994237 A US4994237 A US 4994237A US 43533289 A US43533289 A US 43533289A US 4994237 A US4994237 A US 4994237A
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- solution
- bioprostheses
- preserve
- sterilize
- sodium chloride
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Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L2/00—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor
- A61L2/0005—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor for pharmaceuticals, biologicals or living parts
- A61L2/0082—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor for pharmaceuticals, biologicals or living parts using chemical substances
-
- A—HUMAN NECESSITIES
- A01—AGRICULTURE; FORESTRY; ANIMAL HUSBANDRY; HUNTING; TRAPPING; FISHING
- A01N—PRESERVATION OF BODIES OF HUMANS OR ANIMALS OR PLANTS OR PARTS THEREOF; BIOCIDES, e.g. AS DISINFECTANTS, AS PESTICIDES OR AS HERBICIDES; PEST REPELLANTS OR ATTRACTANTS; PLANT GROWTH REGULATORS
- A01N1/00—Preservation of bodies of humans or animals, or parts thereof
- A01N1/10—Preservation of living parts
-
- A—HUMAN NECESSITIES
- A01—AGRICULTURE; FORESTRY; ANIMAL HUSBANDRY; HUNTING; TRAPPING; FISHING
- A01N—PRESERVATION OF BODIES OF HUMANS OR ANIMALS OR PLANTS OR PARTS THEREOF; BIOCIDES, e.g. AS DISINFECTANTS, AS PESTICIDES OR AS HERBICIDES; PEST REPELLANTS OR ATTRACTANTS; PLANT GROWTH REGULATORS
- A01N1/00—Preservation of bodies of humans or animals, or parts thereof
- A01N1/10—Preservation of living parts
- A01N1/16—Physical preservation processes
- A01N1/168—Physical preservation processes using electromagnetic fields or radiation; using acoustic waves or corpuscular radiation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L2/00—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor
- A61L2/0005—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor for pharmaceuticals, biologicals or living parts
- A61L2/0011—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor for pharmaceuticals, biologicals or living parts using physical methods
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L2/00—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor
- A61L2/02—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor using physical phenomena
- A61L2/08—Radiation
- A61L2/12—Microwaves
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L2/00—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor
- A61L2/16—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor using chemical substances
- A61L2/18—Liquid substances or solutions comprising solids or dissolved gases
Definitions
- This invention relates to a method to prepare biological tissues (e.g. heart valves, veins, cartilage, ligaments) and organs for use as bioprostheses, and more particularly, it relates to a rapid method to preserve tissue samples with a solution, to irradiate samples in a microwave oven, and to store samples in a storage medium.
- biological tissues e.g. heart valves, veins, cartilage, ligaments
- organs for use as bioprostheses
- bioprosthesis One of the earliest examples of replacement tissue (otherwise known as a bioprosthesis) is the porcine valve which was used to replace defective human heart valves. Before any bioprosthesis is implanted, it must be treated with disinfectants and preservatives (such as chemical, x-ray, or cold treatments) to prevent infection and to maintain the structural integrity of the bioprosthesis. If a bioprosthesis were not treated with preservatives, it would degenerate following implantation and fail to function. In the early stages of this technology, bioprostheses were prepared by immersion in a formaldehyde solution prior to implantation.
- disinfectants and preservatives such as chemical, x-ray, or cold treatments
- valves fail to mechanically function properly because the formaldehyde predisposes the valve to either tears in or calcific deposits on the valve leaflets.
- the literature teaches that aldehydes are responsible for the mechanical failure of the valve leaflet.
- the literature currently promotes the use of glutaraldehyde in place of formaldehyde.
- the literature suggests that reducing the exposure time of the bioprosthesis to the glutaraldehyde or formaldehyde and/or reducing the aldehyde concentration (using conventional tanning methods) would have a limited effect in eliminating mechanical valve failure.
- Collagen is a fibrous protein which gives tissues their structural integrity and makes the tissues resistant to tearing. Collagen fibers form an extracellular framework around tissue cells. Aldehydes induce covalent cross-linking, making collagen fibers rigid as the number of covalent cross-linkages increases.
- Aldehydes as a class, are effective antimicrobial agents, Burke et al., Human Lab Science, 13:267 (1976), which combine a number of organic functional groups on proteins (-NH 2 , OH, --COOH, and SH). Spontaneous reactions with the amino groups of proteins leads to protein inactivation by forming methylene-bridged cross-links between amino groups. Sterilization and disinfecting applications of formaldehyde and glutaraldehyde are limited by their slow action (hours) and their uncontrollable reaction rate. Id. In addition, exposure to aldehyde on the order of hours results in irritation of lab workers' respiratory tracts. Science, 222:895 (1983).
- Preparing tissues by present tanning methods requires long exposure times (hours to months) to moderate glutaraldehyde concentrations (0.625% to 5%).
- the long exposure time to glutaraldehyde is thought to be necessary for complete penetration of the tissue as well as for tissue sterilization.
- Mechanical failure, secondary to altered collagen, results in the leading cause of heart valve failure even with glutaraldehyde concentrations as low as 0.625% and with exposure as brief as 24 hours. Broom et al., Thorax, 34:166 (1979).
- fixation procedures In the field of histology, the study of tissue structure, the object is to fix cells by preserving their intra- and extracellular architecture. Since the diffusion of glutaraldehyde into tissues is slow (on the order of hours), fixation procedures usually entail long exposure times of tissue specimens to high aldehyde concentrations. This results in very brittle tissue. Glutaraldehyde (in concentrations of 2% to 4%) is used under certain circumstances in histology (e.g. electron microscopy); formaldehyde (in a 4% concentration) is routinely used (e.g. in light microscopy). The goal of fixation is to preserve all cell types and products, not just collagen.
- tissue specimens which are preserved by means of standard tanning processes incorporating glutaraldehyde tend to tear, calcify, and develop thrombi within 4 to 7 years.
- Tearing of the bioprosthesis results from repeated flexing of the collagen, made rigid by aldehydes.
- Calcification is a condition whereby calcium salts from the bloodstream form deposits on stressed or damaged tissues. These deposits develop into hard obstructions within a patient's body, particularly on valve leaflets.
- a thrombus is a blood clot which is formed at a site of damage to the delicate, internal lining of blood vessels or the heart.
- Blood clot formation can be triggered by rough surfaces, such as calcified leaflets or tears in the endothelial lining, which cause platelets to release potent clotting factors permitting formation of fibrin fibers which trap red blood cells (erythrocytes) thereby decreasing the function of the leaflets.
- rough surfaces such as calcified leaflets or tears in the endothelial lining, which cause platelets to release potent clotting factors permitting formation of fibrin fibers which trap red blood cells (erythrocytes) thereby decreasing the function of the leaflets.
- microwave irradiation in conjunction with a physiologic salt solution or a dilute aldehyde solution, leads to a degree of preservation such that tissue flexibility is promoted and collagen cross-linking is minimized.
- the present invention is a method to provide bioprostheses for implantation into patients.
- OBS osmotically balanced solution
- the immersed tissue is then irradiated in a microwave oven for seconds until the OBS reaches a temperature within the range of 35° C. to 50° C.
- the tissue is transferred and stored in a cold sterile saline solution.
- long exposure time to glutaraldehyde and formaldehyde is limited and/or eliminated.
- the bioprostheses produced by the present invention retain their pliability and other qualities that characterize natural, unpreserved tissue.
- FIG. 1 is a schematic diagram for the procedure of the present invention showing the tissue in a microwave oven
- FIG. 2 is a graph illustrating the ultimate tensile strength of tissue prepared using the "standard glutaraldehyde” treatment
- FIG. 3 is a graph illustrating the ultimate tensile strength of tissue prepared using the method of the present invention at "high temperature";
- FIG. 4 is a graph illustrating the ultimate tensile strength of tissue prepared using the method of the present invention at "low temperature.”
- the broadest aspects of the invention involve removing the tissue from its blood supply, immersing the tissue in an osmotically balanced solution (OBS) initially at room temperature (approximatly 20° C.), irradiating the immersed tissue with microwave energy at a sufficient dose and for a sufficient time such that the temperature of the solution is within the range of 35° C. to 50° C., and storing the tissue in a sterile OBS until it is implanted in a patient.
- OBS osmotically balanced solution
- a glass tray 4 centered on the glass platform of the microwave oven 18 and filled with solution 14 to a maximum height (depth) of 1 cm.
- the microwave temperature probe 6 is immersed in the solution 14 and the oven shut-off temperature is pre-set within the 35° to 50° C. range. (Beyond this range, the important physiologic characteristics of collagen will be altered.)
- the tissue specimens 2 are submerged in the OBS 14.
- the power indicator on the oven 12 is set at maximum or high. Setting the timer on the oven 8 is irrelevant since the extent of the treatment is determined on the basis of the solution temperature.
- the oven 10 is turned on and the tissue specimens 2 are subjected to microwaves 16.
- the microwave energy is supplied by the oven 10 which is either a standard microwave oven or a specially designed microwave oven which further reduces the aldehyde exposure time.
- the duration of the microwave treatment is determined by the temperature of the solution 14, thus the microwave oven 10 will automatically shut off when the pre-set final irradiation temperature of the solution is obtained.
- the tissue specimens 2 are removed from the warm solution and stored in a cold sterile saline solution or OBS as soon as possible and preferably within thirty seconds of irradiation.
- the OBS used for storage of the tissue specimens 2 may contain 0.001%-0.1% glutaraldehyde, a calcium chelating agent such as 1-100 mM ethylenediaminetetraacetic acid (EDTA), 0.02% sodium azide (or other inhibitor of microbial growth such as 0.02% thimerosal), or some combination of these elements.
- glutaraldehyde a calcium chelating agent such as 1-100 mM ethylenediaminetetraacetic acid (EDTA), 0.02% sodium azide (or other inhibitor of microbial growth such as 0.02% thimerosal), or some combination of these elements.
- Osmotically balanced solutions are utilized to prevent the loss of important cellular constituents due to diffusion.
- the solution 14 in which the tissue specimens are immersed is one of the following room temperature OBS: a physiologic saline solution (0.9% sodium chloride), a phosphate buffered saline solution (PBS) consisting of 0.87% sodium chloride, 0.12% sodium phosphate dibasic, and 0.015% sodium phosphate monobasic, a solution of 25 mM N-2-hydroxyethylpiperazine-N 1 -2-ethanesulfonic acid (HEPES), or a solution of 20 mM Tris(hydroxymethyl)aminomethane and 0.9% sodium chloride, pH 7.3-7.6 (TRIS).
- Each of these solutions may also contain 0.001-0.1% glutaraldehyde or a calcium chelator such as 1-100 mM EDTA, or both. Table 1 illustrates the optimal conditions under which these different solutions may be used. Water is the solvent for all solutions.
- the present invention is applicable to known dilute preserving solutions and calcium chelating agents.
- Aldehydes used in the various preserving solutions have a maximum of 6 carbons and are liquids.
- All tissue specimens were harvested from donor animals using surgically clean techniques. All tissues treated with microwave energy had either a good pliable feel or appeared less rigid than those tissues treated in the conventional manner (immersion in a Hancock preparation containing 0.6% glutaraldehyde for 24 hours, followed by storage in 0.2% glutaraldehyde for an indefinite time period typically months or years).
- the object of the present invention is to preserve biologic tissue for implantation into animals or humans such that the bioprosthesis will function physiologically (i.e. resist mechanical failure under physiologic conditions).
- microwave energy is used to irradiate the tissue.
- Microwaves uniformly penetrate and rotate dipolar molecules millions of times a second, thereby heating specimens uniformly and instantaneously, resulting in controlled coagulation of proteins. This is unlike conventional heating in an oven which results in a temperature gradient from the outside to the inside of the specimen.
- Microwaves also induce an electromagnetic field in the biological specimen, which is postulated to stop cell function by rearranging highly oriented molecular assemblies. Cleary, Department of Health, Education, and Welfare (FDA), 78-8055:1, 1978.
- Microwave irradiation is also known to destroy viruses and bacteria, and, thus, sterilize the tissue.
- Rohrer et al. Am. J. Opthalmology, 101:49 (1986); Latimer et al., J. Clin. Microbiology, 6:340 (1977).
- the present invention uses microwave energy in combination with an aldehyde at a concentration below that which is used to preserve cells for histology.
- calcium salts which are in aldehyde fixatives and which are necessary to maintain cell integrity for electron microscopy are omitted in OBS used in microwave preservation of bioprostheses to further prevent calcification.
- Valve leaflets were dissected from pigs under surgically clean conditions within fifteen minutes after the cessation of blood flow. Within fifteen minutes after harvesting, the valve leaflets were rinsed in standard electrolyte solution and fixed using three different treatment methods: (a) immersion in a 0.6% glutaraldehyde solution for 24 hours at 25° C.
- the tensile strengths of the valve leaflets were determined in order to quantitate the structural changes following the various valve treatments. Tensile strength testing is an effective means to investigate detrimental effects of valve preservation/treatment on tissues since tensile strength is a "fundamental parameter" of bioprosthetic function. Pritchard et al., J. Thoracic Cardiovasc. Surg., 52:232 (1966). Better methods of preparing bioprostheses should result in leaflets with high tensile strength--ideally commensurate with natural tissue--since such methods are expected to involve "minimal structural change to the collagen and elastic components" of the tissue. Tan et al., Ann. Thoracic Surg., 22:188 (1976).
- the leaflets were trimmed parallel to the annulus. One 2 mm wide by 1.4 cm long strip of tissue was obtained from each leaflet and trimmed with a thin isthmus, centrally located so as to induce breakage at the isthmus rather than at the clamp. Pritchard et al., J. Thoracic Cardiovasc. Surg. 52:232 (1966). The leaflet strips were held by pneumatic clamps with one clamp face serrated and the other rubber-coated. A 0.1 to 0.25 inch gauge length was used in recording the applied tension. A 500 gram test cell was used (Instron model 4201 mechanical testing machine, Canton, Mass.) with 0.2 inch/minute pulling rate. All strips were tested "wet" (bathed with 0.9% saline solution.)
- the peak on the curve represents the rupture or ultimate tensile strength of the tissue.
- the rupture point of the "standard glutaraldehyde” treated tissue was 220 grams and is shown in FIG. 2.
- the rupture point of the "high temperature” microwave treated leaflet, FIG. 3, was 260 grams which is an 18% increase in the ultimate tensile strength compared to the "standard glutaraldehyde” treated valve.
- the leaflet treated with "low temperature” microwave irradiation, FIG. 4 exhibited a 34% increase in the ultimate tensile strength compared to the "standard glutaraldehyde” treated valve. Its breaking point was 295 grams.
- microwave treatment of bioprostheses reduces the preparation time and maintains higher tensile strength of the tissue than conventional valve tanning methods.
- Our results are in agreement with the literature which states that chemical agents which alter the structure of collagen yield a "striking" 35% reduction in tensile strength compared to fresh, unfixed, tissue controls. Harris et al., Surgery, 63:45 (1968).
- Our results indicate that the microwave method in accordance with the present invention, better approximates the ultimate tensile strength characteristics of the living tissue.
- pig valve leaflets were exposed to a variety of osmotically balanced solutions and microwave conditions, and evaluated for calcification following implantation into rats.
- Leaflets were harvested as previously reported in Study I and immersed in the following solutions initially at room temperature: (a) 0.1-0.5% glutaraldehyde in PBS, and (b) 0.1-2.5% glutaraldehyde plus 2.0% formaldehyde plus 0.025% calcium chloride in 0.1 M sodium cacodylate buffer (a standard fixative formulation for electron microscopy).
- the leaflets were exposed to microwave energy for 5-8 seconds as soon as possible and preferably within fifteen minutes after immersion in solution (a) or (b).
- the final solution temperature ranged between 36° C. and 47° C.
- Leaflets were rinsed in room temperature 0.9% sodium chloride and implanted subcutaneously in surgically prepared pouches along the abdominal wall of 3 week old, phenobarbital anesthetized rats. The rats were sacrificed 3 weeks following implantation, and ten leaflets were harvested, fixed in 10% formalin and processed to paraffin blocks. Sections 4 microns thick were stained with hematoxylin and eosin and examined by light microscopy.
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Abstract
Description
TABLE 1 __________________________________________________________________________ Sample Solution Final Microwave Composition Irradiation Solution Solution (solvent = H.sub.2 O) Time Temperature __________________________________________________________________________ physiologic 0.9% sodium chloride 1-50 s 35°-50° C. saline PBS 0.87% sodium chloride, 1-50 s 35°-50° C. 0.12% sodium phospate dibasic and 0.015% sodium phosphate monobasic HEPES 25 mM HEPES 1-50 s 35°-50°C. TRIS 20 mM Tris and 0.9% 1-50 s 35°-50° C. sodium chloride buffered 1-100 mM EDTA in 1-50 s 35°-50° C. calcium 0.9% sodium chloride, chelator PBS, HEPES or TRIS buffered 0.001-0.1% glutaraldehyde 1-50 s 35°-50° C. glutaraldehyde in 0.9% sodium chloride, mixture PBS, HEPES or TRIS buffered 1-100 mM EDTA plus 1-50 s 35°-50° C. calcium 0.001-0.1% glutaraldehyde chelator and in 0.9% sodium chloride, glutaraldehyde PBS, HEPES or TRIS mixture __________________________________________________________________________
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